States Public Health Service Hospital Research Articles

ADDICTION TO MEPERIDINE HYDROCHLORIDE (DEMEROL HYDROCHLORIDE)

Numerous patients addicted to meperidine hydrochloride (Demerol hydrochloride) have been admitted to the United States Public Health Service Hospital, Lexington, Ky. Several had been addicted to opiates before becoming addicted to meperidine hydrochloride. Many used this drug and morphine sulfate concurrently. Prior to September 1946 cases of addiction to this drug had not been reported in the American literature, except in persons previously addicted to the opiates. Three cases of addiction to meperidine hydrochloride are here reported. Two patients have never been addicted to any other narcotic drug and 1 used morphine when sufficient meperidine hydrochloride was not available. REPORT OF CASES Case 1.— Patient A, a white man volunteer aged 27, had sixteen abdominal operations between 1929 and 1941. He had received a proprietary preparation of the total alkaloids of opium as soluble hydrochlorides (Pantopon) and occasionally morphine sulfate as preoperative and postoperative medication. He emphatically denied experiencing positive

CHRONIC PSYCHOSES AND ADDICTION TO MORPHINE

THE PSYCHOSES attributed to the use of morphine may be classified as follows: (1) chronic psychoses due to habitual use; (2) psychoses due to withdrawal, and (3) psychoses due to idiosyncrasy. At the United States Public Health Service Hospital, Lexington, Ky., which is devoted primarily to the treatment of drug addiction and at which this study was made, there has been little experience with the last type (psychoses due to idiosyncrasy), since the patients are addicts and therefore habitually use large doses of morphine. However, it has been stated that this type of psychosis does occur 1 but is rare and occurs more frequently in women. It is characterized by excitement or delirium. due to withdrawal constitute a separate problem. This study is concerned with an evaluation of the first type, chronic psychoses due to habitual use of morphine. Psychoses due to opium or its derivatives is listed in

Narcotic Drug Addicts

IN Supplement No. 170 of Public Health Reports Dr. Michael J. Pescor, assistant surgeon, United States Public Health Service, records a follow-up study of 4,766 narcotic drug addicts who had been discharged from the United States Public Health Service Hospital at Lexington, Kentucky, during January 1, 1936-December 31, 1940. The results were as follows: The present state could not be determined in 39.6 per cent of the cases ; 7.0 per cent died after discharge ; 39.9 per cent returned to the use of drugs and 13.5 per cent were still abstinent. Excluding the dead and the unknown, 74.7 per cent had relapsed and 25.3 per cent were still abstinent. 57 per cent of the patients gave no history of subsequent admission to any institution ; 19.9 per cent were re-admitted to other institutions, 16.0 per cent returned to the Lexington Hospital only and 7.1 per cent were re-admitted both to the Lexington Hospital and other institutions. According to Pescor the theoretically ideal patient, that is the one with the best prospects for a permanent cure, is the one who stays in the hospital for 2.5 months, after which he is discharged on parole for a period of supervision of 2.5 months, during which he would have home employment.

MYCOTIC ENDOCARDITIS

Endocarditis due to fungi is an exceedingly rare clinical entity. Joachim and Polayes1described a case of subacute endocarditis with systemic mycosis (moniliasis) in a drug addict and referred to another case in which autopsy revealed evidence of mycotic endocarditis. The following case, also in a drug addict, is similar in many respects to that of Joachim and Polayes and is considered worthy of reporting because of its apparent rarity, and because of its possible public health importance, since these cases occurred in drug addicts. A white man aged 49 was admitted to the United States Public Health Service Hospital on May 11, 1940 for treatment of drug addiction (heroin) which dated from 1914. His previous medical and personal history showed nothing relevant to the present report. Physical examination on admission was negative except for many missing and some artificial teeth, defective vision and hemorrhoids. Serologic tests for syphilis